Esthesioneuroblastome : dilemme diagnostic et challenge therapeutique

Introduction : L’esthesioneuroblastome est une tumeur maligne rare des fosses nasales. Il s’agit d’une tumeur agressive et recidivante dont le traitement est controverse. Notre objectif est de decrire les particularites diagnostiques et les actualites therapeutiques de cette tumeur. Materiels et methode : Etude retrospective sur une periode de 10 ans (2001-2010), ayant interesse trois cas d’esthesioneuroblastome colliges dans notre service. Resultats : Il s’agit de 3 patients âges respectivement de 23, 30, 85 ans. Les signes fonctionnels sont l’obstruction nasale, l’epistaxis et les cephalees. L’endoscopie nasale a trouve un processus tumoral endonasal dans tous les cas. Des adenopathies cervicales ont ete retrouvees dans un cas. Le scanner du massif facial et la biopsie tumorale, realises dans les trois cas, ont permis de classer la tumeur respectivement aux stades B, C, A, selon la classification de KADISH. L’association chirurgie- radiotherapie a ete preconisee dans deux cas et chimio-radiotherapie dans un cas. L’evolution a ete favorable dans 2 cas. Le troisieme patient a ete perdu de vue. Discussion : le diagnostic d’esthesioneuroblastome est souvent tardif. L’imagerie est indispensable pour l’orientation de la strategie therapeutique. L’association chirurgie radiotherapie constitue le traitement de reference. La chimiotherapie gagne de plus en plus d’interet. Mots Cles : Esthesioneuroblastome; traitement; chirurgie; radiotherapie; chimiotherapie; pronostic Introduction : Esthesioneuroblastoma is a rare malignant tumor of the nasal cavity. It is an aggressive tumor, associated with a high level of recurrence. Treatment is still controversial. The object of our report is to describe the clinical presentations and new therapeutic approaches of this tumor. Material and methods : We retrospectively reviewed three patients with nasosinusal esthesioneuroblastoma who were managed during a period of 10 years (2001- 2010). Results : the three patients were aged respectively of 23, 30 and 85 years. Functional signs were mainly nasal obstruction, epistaxis and headache. Nasal endoscopy found an endonasal tumor process in all cases. Cervical lymph nodes were noted in one case. The CT scann and the tumor biopsy were performed in all three cases. Esthesioneuroblastoma was classified, respectively in stage B, C and A, according to KADISH classification. The association surgery-radiotherapy has been advocated in both cases and chemo-radiotherapy in one case. The outcome was favorable in two cases. The third patient was lost to view. Discussion : The ENB is a rare neuroepithelial cancer of the nasal cavity. Its diagnosis is often delayed due to its nonspecific clinical presentation. Radiography is of a great contribution for the diagnosis and for guiding the therapeutic strategy. Surgery and radiotherapy are currently the recommended treatment modality. Chimiotherapy is a new therapeutic approach. Key Words : Esthesioneuroblastoma; treatement; surgery; radiotherapy; chimiotherapy prognosis.